Serena Perry inquest hears call for community treatment orders

The manager of adult mental health services for the Horizon Health Network in the Saint John area says it's time for New Brunswick to implement community treatment orders.

Nora Gallagher says she also supports more security for psychiatric units, such as locked doors and camera surveillance.

Gallagher made the comments while testifying Thursday at the coroner's inquest into the death of Serena Perry.

Perry, 22, an involuntary psychiatric patient at the Saint John Regional Hospital, was found dead on Feb. 14, 2012, in the amphitheatre, which is located in another part of the hospital. She had a blue garment wrapped loosely around her neck.

The inquest is being held to determine the facts surrounding Perry's death. The five-member jury may also make recommendations aimed at preventing similar deaths.

"We were not able to make her take her medications consistently and be well," said Gallagher.

"I believe the time has come to change the [Mental Health] Act to support community orders. We are one of only two provinces that hasn't moved in that direction," she said.

New Brunswick and the territories are the only places in Canada that don't have community treatment legislation to ensure patients like Perry take their medication, under supervision, while living in the community.

Earlier in the inquest, the jury heard Perry suffered from paranoid schizophrenia and would not take her medication when she was not hospitalized. It was the third time Perry had been admitted to the psychiatric unit.

Gallagher, who was responsible for the psychiatric unit at the time, described herself as a long-time mental health patient advocate, concerned about patients' rights and ethics.

She says at the time of Perry's death, she did not agree with such coercive measures, because they were against best practices and research.

But patients are "sicker and far more complex" now, and institutions are moving to more risk reduction, she said.

"The time has come when we need to enhance security."

Several changes have been made to control the movements of patients at the Saint John Regional Hospital's psychiatric unit since Perry's death, the inquest has heard.

For example, the doors in and out of the unit are now locked and there's a buzzer system, there are surveillance cameras and signs were put up so patients know they are being watched.

But Dr. Laurie Potter, an adult psychiatrist who introduced many of the security changes, told the inquest she doesn't think they would have saved Perry.

Perry and the male patient she was last seen with both had privileges to leave the ward the night of Perry's death because they were responding well to treatment, said Potter, who spent seven years working in the psychiatric unit and now practices in Guelph, Ont.

A hospital has to prepare patients to return to the community and respect their need for a therapeutic environment that doesn't feel like jail, she said.

Perry had left the psychiatric unit twice with a fellow male patient on the night she died. But on the second occasion, they did not sign out and the male patient returned alone, the Saint John courtroom heard.

Saint John police had treated her death as a homicide and the male patient was considered a suspect, but no charges were ever laid because the exact cause of death could not be determined.

Three weeks have been set aside for the inquest.